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IIR 12-118 – HSR&D Study

IIR 12-118
Women Veterans Cohort Study 2
Sally Haskell MD
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
West Haven, CT
Funding Period: July 2014 - September 2019

The proportion of women in the military, their roles, and their exposure to combat changed dramatically during Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (OEF/OIF/OND). With a young cohort of returning Veterans, VHA must focus on prevention. Strategies that VHA develops will reduce the burden of chronic disease faced by individual Veterans and by the healthcare system. Understanding the prevalence of disease by gender, and risk factors for developing disabling conditions, is of paramount importance in VHA's ability to create programs that are specific to women and to mitigate disparities in healthcare and health outcomes for women Veterans. Women Veterans have higher risks of musculoskeletal conditions and chronic pain than men, and poorer control of cardiovascular risk factors. Women Veterans are using VHA for mental healthcare yet little is known about women's experiences with these services. This study will provide a better understanding of experiences and needs of women Veterans for preventive services.

In WVCS 2, we will expand on WVCS 1, and use the Electronic Health Record Cohort of all VA enrolled OEF/OIF/OND Veterans, and an expanded prospective survey cohort of OEF/OIF/OND Veterans to identify longitudinally, the 1) predictors of, 2) psychiatric and psychosocial moderators of, 3) treatment patterns for, and 4) barriers to care for painful musculoskeletal conditions, mental health conditions, and CVD risk uniquely experienced by women Veterans. Our aims are to 1) determine the pattern of disease onset and progression among women OEF/OIF/OND Veterans compared to men, 2) determine the unique psychiatric and psychosocial moderators of disease progression for women OIF/OEF/OND Veterans, 3) determine unique care patterns for women OIF/OEF/OND veterans, and 4) determine the barriers to care that arise for women Veterans.

We created an electronic medical record (EMR) cohort of male and female Veterans from the OEF/OIF/OND roster and VA electronic administrative and clinical data, and supplemented the data in this cohort with a prospective survey. As of June 2017, the EMR-based cohort includes administrative and clinical data from the Corporate Data Warehouse (CDW) for over 1.2 million Veterans. The prospective baseline survey has been completed by 1138 Veteran volunteers so far. A follow-up survey is being distributed.
WVCS 2 is a mixed methods study focusing on longitudinal evaluation of health outcomes associated with three major areas, musculoskeletal pain, cardiovascular risk, and mental health in women Veterans. Using data from the EHR Cohort, data from the Survey Cohort and information from telephone interviews, we will determine patterns of disease onset and progression in women Veterans for these three major areas.
The main research methods will include, 1) collection and analysis of existing and newly available VA electronic health record and administrative data, 2) additional surveys to an expanded catchment area to include Los Angeles, CA and Durham, NC, in addition to the original WVCS wave 1 catchment areas of Indiana and Illinois and the six New England States, and 3) performance of one-on-one telephone interviews from 4 Women's Health Practice Based Research Network sites (West Haven CT, Los Angeles CA, Durham NC and Northampton MA VAs) to obtain important qualitative data to understand more about OEF/OIF/OND women Veterans' experiences with VA specialty care for musculoskeletal, cardiovascular, and/or mental health conditions.

Dr. Haskell's paper "Incident Cardiovascular Risk Factors among Men and Women Veterans after Return from Deployment" (19) was shared with the VA-DoD Health Executive Committee, Women's Health Work Group. The steep trajectory of CV risk in both men and women Veteran, with higher rates among Black women and those with Depression were highlighted. Because women Veterans are more likely to identify as racial/ethnic minorities than men Veterans, and because of high rates of depression among women Veterans, these results were considered important for tailoring preventive strategies to meet the needs of women Veterans. The paper significantly impacted the decision of the HEC Women's Health Workgroup to pilot a women's health specific transition assistance program.
This pilot program aims to educate women Veterans about VA Women's Health Services and improve enrollment rates of women in VA care in order to target cardiovascular prevention, among other end points. Our work has also been shared with the VA-American Heart Association Go Red Partnership-which is an ongoing effort to raise awareness of heart disease among women Veterans.
Dr. Driscoll's paper "Trauma, Social Support, Family Conflict, and Chronic Pain in recent Service Members: does gender matter" helped delineate the importance of social support for women with Chronic pain and formed the nidus for her pilot project-that is currently supported by a VISN 1 CDA award-and is testing the implementation of a peer support pain management program for women Veterans. The program is already achieving significant success. In addition we have published several other papers: "Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014" and "Examining Gender as a Correlate of Self-Reported Pain Treatment Use Among Recent Service Veterans with Deployment-Related Musculoskeletal Disorders".

We continue to use the WVCS 2 to continue a longitudinal analysis of gender differences in risk for chronic disease (pain, cardiovascular and mental health conditions) after deployment in OEF/OIF/OND to provide information that will ultimately assist VA in tailoring gender specific prevention and treatment programs.

External Links for this Project

NIH Reporter

Grant Number: I01HX000915-01A2

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None at this time.

DRA: Health Systems, Cardiovascular Disease, Musculoskeletal Disorders
DRE: Prevention, Epidemiology
Keywords: Cardiovascular Disease, Gender Differences, Outcomes - Patient, PTSD, Risk Factors, Sexual Trauma/Assault, Social Support, Utilization, Depression
MeSH Terms: none

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